APPENDIX
Ohio Department of Agriculture
Division of Animal Industry
Integrated Wildlife Damage Management Plan (IWDMP) Agreement Form
Date _______________
Name ________________________________________________
Address ______________________________________________
City ____________________ State _____ Zip ________ County ________
Telephone _______________ Cell Phone _________________
Latitude _________________ Longitude __________________
Type of Livestock ___________________ Number ______________________
Number of losses/injuries within the last 12 months and type of predation:
________________________________________________________________
________________________________________________________________
Type of practices (lethal/non lethal) currently implemented to reduce livestock predation:
________________________________________________________________
________________________________________________________________
Describe deficiencies with current practices relating to predation:
________________________________________________________________
________________________________________________________________
List specific recommendations needed to be implemented:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Equipment and/or supplies required to implement plan:
________________________________________________________________
________________________________________________________________
I agree to implement the above described recommendations in order to be paid for additional claims in this fiscal year.
________________________________ _______________________________
Owners Signature Date Designated Official Date
Ohio Admin. Code 901:1-24-02
Promulgated Under: 119.03
Statutory Authority: 955.52
Rule Amplifies: 955.51, 955.52, 955.53
Prior Effective Dates: 150 v S 202 eff. 4/15/05, 07/17/2006